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Medicine > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What is blood pressure?

A

The outwards (hydrostatic) pressure exerted by the blood on the blood vessel walls/

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2
Q

What is the systemic systolic arterial blood pressure?

A

The pressure exerted by the blood on the walls of the aorta and systemic arteries when the heart contracts”: should not normally reach or exceed 140 mm Hg under resting conditions

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3
Q

What is the systemic diastolic blood pressure?

A

The pressure exerted by the blood on the walls of the aorta and systemic arteries when the heart relaxes”: should not normally reach or exceed 90 mm Hg under resting conditions

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4
Q

What is the normal flow of blood in arteries called?

A

Laminar flow

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5
Q

What sounds are heard in laminar flow

A

No sounds

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6
Q

What is the first Korotkoff sound?

A

The peak systolic pressure

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7
Q

What are the 2nd and 3rd Korotkoff sounds?

A

Intermittent sounds are heard as a result of turbulent spurts of flow cyclically exceeding cuff pressure

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8
Q

What pressure do korotkoff sounds 1-3 become audible?

A

Between 120mmHg and 80mmHg

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9
Q

What is the 4th Korotkoff sound?

A

The last sound, heard at minimum diastolic pressure. (muffled/muted)

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10
Q

What is the 5th Korotkoff sound?

A

No sound is heard at this point because of uninterrupted, smooth, laminar flow.

At this point diastolic pressure is recorded

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11
Q

When are the 4th and 5th Korotkoff sounds present?

A

When cuff pressure is less than 80mmHg.

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12
Q

What is the right atrial pressure?

A

Close to zero

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13
Q

What does the pressure gradient between the aorta and the right atrium responsible for?

A

Driving blood around the systemic circulation

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14
Q

What is the formula for the pressure gradient between the AO and RA?

A

Pressure Gradient= Mean Arterial Pressure (MAP) - Central Venous (right atrial) pressure (CVP

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15
Q

What is mean arterial blood pressure? (MAP)

A

Mean Arterial blood pressure is the average arterial blood pressure during a single cardiac cycle, which involves contraction and relaxation of the heart.

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16
Q

What is longer? Systolic or diastolic?

A

Diastolic is almost twice as long

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17
Q

What formula can be used to estimate MAP?

A

[(2 x Diastolic pressure) + systolic pressure]

3

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18
Q

What is another way to estimate MAP?

A

by adding DBP + 1/3rd of pulse pressure

MAP=DBP+1/3

(difference between SBP and DBP)

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19
Q

What is the normal range for MAP?

A

70-105 mmHg

MAP of at least 60 mmHg is needed to perfuse the coronary arteries, brain and kidneys

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20
Q

What is the relationship between;

  • MAP
  • CO
  • TPR
A

MAP= CO x TPR

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21
Q

What is CO?

A

CO is cardiac output, the vlume pumped by each ventricle of the the heart per minute

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22
Q

How can we calculate CO?

A

CO= SV x HR

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23
Q

What is SV?

A

Stroke volume (SV) is the volume of blood pumped by each ventricle of the heart per heart beat

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24
Q

What is TPR?

A

Total peripheral resistance is the sum of resistance of all peripheral vasculature in the systemic circulation.

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25
Q

What are the major resistance vessels?

A

The arterioles

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26
Q

What is the baroreceptor reflex responsible for regulating?

A

Short term regulation of mean arterial blood pressure

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27
Q

Where are the baroreceptors and how do each group send signals to the brain?

A
  • aortic arch- via Xth CN
  • carotid sinus- via IXth CN
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28
Q

What is postural hypotension?

A

Results from failure of baroreceptor responses to gravitational shifts in blood, when moving from horizontal to vertical position.

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29
Q

What happens to the baroreceptor reflex if there is an;

  1. increase in ABP
  2. decrease in ABP
A
  1. increases the rate of firing
  2. decreases the rate of firing
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30
Q

What is the ECFV?

A

extracellular fluid volume is the fluid which bathes the cells and acts as the go-beteen the blood and body cells

31
Q

How can ECFV be calculated?

A

ECFV = PV + IFV

PV (plasma volume)

IFV (interstitial fluid volume)

32
Q

What happens if plasma volume falls?

A

Compensatory mechanisms shifts fluid from the interstitial compartment to the plasma compartment.

33
Q

What two factors affect ECFV?

A
  1. Water excess or deficit
  2. Na+ excess or deficit
34
Q

What do hormones regulate?

A

They act as effectors tp regulate the ECFV (including PV) by regulating the water and salt balance in our bodies.

35
Q

What hormones regulate ECFV

A
  1. The renin-angiotensin-aldosterone system (RAAS)
  2. Atrial Natriuretic Peptise- ANP
  3. Antidiuretic Hormone (Arginine Vasopressin) ADH
36
Q

What does RAAS regulate?

A

Plasma volume and TPR, hence MAP

37
Q

Where is renin released from and what does it stimulate?

A

The kidneys, it stimulates the formation of angiotensin I in the blood from angiotensin II produced by the liver.

38
Q

What converts angiotensin I to angiotensin II and where is it produced?

A

Angiotensin converting enzyme- ACE (produced by pulmonary vascular epithelium)

39
Q

What does angiotensin II stimulate the release of and where from?

A

Aldosterone from the afrenal cortex

40
Q

What does aldosterone cause

A

Systemic vasoconstriction- increasing TPR and stimilating thirst and ADH release, contributing to increasing plasma volume

41
Q

What is aldosterone?

A

A steroid hormone responsible for increasing sodium and water retention in the kidneys- increasing plasma volume

42
Q

Which mechanisms stimulate the release of renin from the juxtaglomerular apparatus in the kidneys?

A
  1. renal artery hypotension- caused by systemic hypotension (reducing BP)
  2. Stimulation of renal sympathetic nerves
  3. Decreased [Na+] in renal tubular fluid- sensed by macula densa of kidney tubules
43
Q

What is the role of Atrial Natruiretic Peptide?

A

It is released in response to hypervolaemic states, causing excretion of salt and water in the kidneyrs, thereby reducing blood volume and blood presure

44
Q

What does Atrial Natruiretic Peptide act as?

A

A vasodilator and a counter-regulatory mechanism for the renin-angiotensin-aldosterone system (RAAS)

45
Q

What effect does Atrial Natruiretic Peptide have on renin release?

A

It decreases renin release

46
Q

Where is vasopressin (ADH) synthesised and stored?

A

Synthesised- The hypothalamus

Stored- Posterior Pituitary

47
Q

What two factors stimulate ADH release?

A
  1. Reduced extracellular fluid volume
  2. Increased extracellular fluid osmolarity

(the normal osmolarity of extracellular fluid is about 280milli-osmoles/l)

48
Q

Where is plasma osmolarity monitores and what happens if it is increased?

A

It is monitored by osmoreceptors- mainly in the brain- in close proximity to the hypothalamus- increased plasma osmolarity will stimulate the release of ADH

49
Q

What does ADH do?

A

Acts in the kidney tubules to increase the reabsorption of water (conserve water)

50
Q

What does increased ADH do to ECFV and PV

A

It would increase them therefore increase CO and BP

51
Q

What does ADH so to blood vessels and what is the significance of this?

A

Causes vasocontriction and increases TPR and BP

52
Q

What are capillary walls composed of?

A

Single layer of endothelial cells

53
Q

What does the capillary wall allow?

A
  • rapid exchange of
    • gases
    • water
    • solutes with interstitial fluid
  • Delivery of O2 to cells
  • Removal of metabolites from cells
54
Q

What regulates blood flow in most tissues?

What is the other method of regulating capillary blood flow?

A

Terminal arterioles regulate regional blood flow to the capillary bed

precapillary sphincters regulate flow in a few tissues

55
Q

What law does the movement of gases and solutes follow?

A

Ficks law of diffusion

56
Q

How do lipid soluble substances cross the membrane?

A

They go through the endothelial cells

57
Q

How do water soluble substances cross the membrane?

A

They go through water-filled pores

58
Q

How is transcapillary fluid flow driven?

A

By pressure gradients across the capillary wall

59
Q

What forces are involved in transcapillary fluid flow?

(starling forces)

A

Forces favouring filtration

  • Pc - capillary hydrostatic pressure
  • πi - interstitial fluid osmotic pressure

Forces opposing filtration

  • πc -capillary osmotic pressure
  • Pi - interstitial fluid hydrostatic pressure (-ve in some tissues)
60
Q

What do starling forces favour at the arteriolar and venular end respectively?

A

Filtration

and

reabsorption

61
Q

How is excess fluid returned to the circulation?

A

Via the lymphatics as lymph

62
Q

What is the normal range of pulmonary capillary hydrostatic pressure?

A

~8-11 mmHg

63
Q

What is the capillary osmotic pressure?

A

25 mmHg

64
Q

What is the definition of oedema?

A

Accumulation of fluid in interstitial space

65
Q

What are the causes of oedema?

A
  1. Raised capillary pressure
  2. Reduced plasma osmotic pressure
  3. Lymphatic insufficiency
  4. Changes in capillary permeability
66
Q

What causes raised capillary pressure?

A

arteriolar dilatation

raised venous pressure;

  • prolonged standing*
  • right ventricular failure*
  • left ventricular failure*
67
Q

Where will oedema caused by left ventricular and right ventricualr failure gather respectively?

A

Pulmonary oedema

Peripheral oedema (ankle, sacral)

68
Q

What reduces plasma osmotic pressure?

A

malnutrition

protein malabsorption

excessive renal excretion of protein

hepatic failure

69
Q

What causes lymphatic insufficiency?

A

lymph node damage

filariasis- elephantiasis

70
Q

What can change capillary permeability?

A

Inflammation

histamine increases leakage of protein

71
Q

Where is the fluid situated in pulmonary oedema?

A

Interstitial and intraalveolar lung spaces

72
Q

What manifests from left ventricular failure and how can it be diagnosed?

A

SOB

Crepitations in auscultations of lung bases

Chest X-ray shows haziness in perihilar region

73
Q

Where is pitting oedema found?

A

Right ventricular failure;

Ankles

Sacrum

74
Q
A

Medicine (9 decks)

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